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December 13, 2019

The debate over 'surprise' billing isn't over: House lawmakers unveil a dueling proposal

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    House Ways and Means Committee Chair Richard Neal (D-Mass.) and Ranking Member Kevin Brady (R-Texas) on Wednesday announced the committee has come up with a compromise bill to address so-called "surprise" medical bills.

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    The announcement comes just days after the Senate Health, Education, Labor and Pensions (HELP) Committee and the House Energy and Commerce Committee announced their own bipartisan plan to address surprise medical bills. Analysts say the influx of a new proposal essentially eliminates any chance that Congress will be able to pass a final bill on the issue in 2019.

    Details on the new bill

    The House Ways and Means Committee's leaders released few details on the new proposal, which is still being finalized, but the release indicates the bill could take a different approach to addressing surprise medical bills then what has been proposed in the House Energy and Commerce and the Senate HELP Committees' compromise bill.

    For example, the Ways and Means bill would base patient cost-sharing for out-of-network bills on the in-network rate for a given area, while the House Energy and Commerce and Senate HELP Committees' bill would set payment rates for out-of-network care based on a benchmark of the median in-network rate in a given area. It is not yet clear how the new system proposed in the Ways and Means legislation would function.

    In addition, the Ways and Means bill proposes a more "robust reconciliation process" than the Energy and Commerce-Senate HELP bill. For instance, the Ways and Means bill would not set a specific threshold at which point providers and insurers could begin the reconciliation process, meaning the process could be triggered over any billing discrepancy.

    In comparison, the Energy and Commerce-Senate HELP bill would create a baseball-style arbitration process that would allow health care providers and insurers to appeal claims over $750.

    The Ways and Means bill would aim to avoid overuse of the reconciliation process by penalizing the losing party and requiring them to pay a reconciliation process fee. The bill also would set a pre-determined threshold for use, and providers and insurers that are considered to be overusing the process would face a surcharge. The bill also would require "annual reporting of the decisions rendered through the process."

    The Ways and Means proposal also would preserve existing state laws regarding surprise bills.

    Next steps

    Neal and Brady called on Congress to delay legislative action on surprise medical bills until 2020 to give lawmakers more time to work on a final compromise package.

    "It's really important to get this solution right, both for patients and for providers and insurers to make sure it's balanced, so it's important that Congress not rush into a solution," Brady said. He added, "Chair Neal and I believe this should be the first issue Congress takes up when we get back after the first of the year."

    Provider groups also have called on Congress to slow down and take more time to come up with a workable legislative solution to surprise medical bills.

    Federation of American Hospitals President and CEO Chip Kahn said, "We're encouraged that the House Ways and Means Committee has joined the deliberations with fresh bipartisan thinking to protect patients from surprise medical bills."

    However, the delay is at odds with the House Energy and Commerce and Senate HELP Committees' leaders' plans to pass a final bill by the end of the year.

    A congressional aide who is supportive of the Energy and Commerce-Senate HELP compromise told Modern Healthcare that delaying action on surprise bills also could delay other issues that lawmakers had planned to pass alongside the legislation, including funding for community health centers  (Cohen, Inside Health Policy, 12/11 [subscription required]; Cohrs, Modern Healthcare, 12/11; Sullivan/Hellman, The Hill, 12/11).

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